مجله دانشگاه علوم پزشکی رفسنجان
سال نهم شماره 4 (پیاپی 37، زمستان 1389)

As depression is a common comorbid disorder with Alzheimer disease, it is important to recognize treatments with more effective and less adverse effects. This study has been devised to comparatively evaluate the effects of desipramine and sertraline in this patients. In this single blind clinical trial study, during January 2005 to April 2008, 63 outpatients in Ibn-e-Sina and Ghaem University hospitals in Mashhad city (north eastern part of Iran) were randomly allocated to two groups: 29 cases were treated by desipramine and 34 patients were treated with sertraline (both 25mg/day and if needed up to 150 mg/day). Patients were assessed at 2, 4, 8 and 12th week by PDRS, HRDS and MMSE and side effects of medications. Short outcome was measured by CSDD. Data were analyzed by SPSS with Fisher exact test and repeated measured ANOVA. Changes in mood with HRDS and CSDD have shown that sertraline was effective in all weeks (p<0.05). In contrast, desipramine had no therapeutic effect except in the 12th week according to HRDS scale (p<0.05). Differences between the groups were significant (p=0.02). Differences between daily activating scales regarding PDRS in 8th and 12th week in desipramine group were statistically meaningful (p<0.05), but not in the sertraline group and between the two groups (p=0.6). Also, cognitive changes by MMSE were not significant in the two groups (p>0.05) and between the two groups (p= 0.11). Sertraline is more effective than desipramine in the treatment of depression in patients who suffer from alzheimer disease, but they are ineffective on cognitive problems.

Thyroid disorders are among the most prevalent autocrine diseases. The aim of this study was to compare the prevalence of thyroid autoantibodies and iodine consumption in hypothyroid patients and healthy subjects. This cross-sectional study was performed through simple non-probability sampling on 75 hypothyroid subjects (TSH >5 mIU/ml, T4 <60 nmol/L and T3RUP=30 - 40%) age 20-75 (M/F=28/47) as cases, and 75 normal individuals (TSH and T4 normal, sex and age matched with the case group) as control. Urinary iodine concentration, antithyroperoxidase (Anti-TPO) and antithyroglobulin (Anti-Tg) were measured in all individuals. Statistical analysis was done in SPSS12, using t-test and Fisher’s exact test. P-value of <0.05 was considered statistically significant. In hypothyroid individuals urinary iodine concentration was less than the control group (p<0.0001), whereas Anti-TPO and Anti-Tg were significantly higher (p<0.0001 and p<0.0001 respectively). Fifty percent of the subjects, above 60 years old, had urinary iodine deficiency. Thyroid autoimmunity is one of the main causes of hypothyroidism in Rafsanjan city and it seems that autoimmunity is not due to the increase of iodine consumption. In addition, iodine deficiency is a health problem in elderly individuals in this study and considering the special conditions of these individuals it must be replaced with other manners.

Central nervous system is one of the primary targets of the detrimental effects of narcotics. Although opiates are among the most drugs of abuse, little is known about their side effects on the brain structures. Most investigations in this field are about their biochemical or psychological side effects. In this study pathologic changes in morphine dependent rats have been investigated.

In this double blind experimental study, 48 male wistar rats were divided into 6 groups. The dependent groups received 0.4mg/ml morphine in drinking water for 7, 28 and 56 days. The control groups received a solution of saccharose in drinking water for the same periods and then the histological studies of the brain samples were done.

Significant neuronal loss in frontal and parietal lobes and hippocampus was observed. Results also showed a significant relationship between the duration of morphine intake and neuronal loss.

The results of this study, in line with the other studies in this field indicate that opiate drugs might induce neuronal damage after long term exposure. These changes could be more significant in chronic addiction. Since brain atrophy is the most common pathology in dementia, further investigations for finding probable relations between dementia and opiate dependency is suggested.

Inhaling Environmental Tobacco Smoke (ETS), as a world health problem, threats the community especially mothers and newborns. The aim of this study was to determine the effects of passive tobacco smoking during pregnancy on mother and newborns. In this Cross sectional study, in one year, 641 non smoking women who refered to Rafsanjan Nicknafs hospital for bearing a singleton baby, were interviewed at least two hours after delivery using a structured check list. Based on history of exposure to ETS, the study samples were divided into two groups and then maternal and newborn outcomes in the two groups were compared by t, Fisher Exact, χ2, and Pearson tests. Exposure to ETS was reported among 25% of respondents. The women exposed to ETS were less educated, multi gravid, had irregular prenatal care, older unemployed, lived in rural and in sum had low socio-economical status. They had higher rates of vaginal delivery) p=0.02), anemia (p=0.048 (and preterm delivery (p=0.002). But mother's exposure to ETS did not show any significant statistical relations with newborn weight, APGAR score, sex, anomaly and preeclampsia and the way of beginning the delivery Exposure to environmental tobacco smoke in pregnancy probably increases the risk of preterm labor and maternal anemia.

Because of high prevalence of severe labor pain and adverse complications for the mother and baby, seeking methods for pain relief is necessary. Continuous midwifery support is one of the nonpharmacologic methods of pain relief. The aim of this study was to determine the effect of continuous midwifery support on the pain intensity of labour and delivery. In this clinical trail, 100 primiparous women in delivery department of Emam Hossein hospital in Zanjan, Iran, in 2007, were randomly selected and divided into two groups. The exprerimental group received continuous midwifery support based on the effective management of normal childbirth, consistsing of: emotional support, information support, and physical support. The control group received only usual care. The scale of collection of data was questionnaire and check list. Data were analyzed using descriptive and analytic methods (t-test, chi-squre and Mann-Whitney tests). Pain intensity of Labour (p=0.002) and the second stage of delivery (p=0.009) among the supported or (experimental) group was less than that of the control group. Duration of labour (p=0.005) and second stage of delivery (p=0.001) in the supported group was also less than that of the control group. There was no relations between pain intensity with age, educatinal level, job and economic status. Continous midwifery support along with management of normal childbirth principles reduce intensity of pain labour and delivery.

Opioids are an important group of analgesics that are used extensively to control sever pains. Physical dependence to these drugs is a major problem. There are a few studies regarding the involvement of cholecyctokinin (CCK) in the withdrawal syndromes of opioids. In the present study, the effects of CCK agonist and antagonist on the number of jumping of morphine dependent mice were evaluated. In this experimental study, the effects of CCK-8 and LY225910 (selective CCK2 receptor antagonist) on jumpings of mice after morphine dependence were evaluated. Mice were injected with morphine three times a day (50, 50 and 75 mg/kg) for three days; at the forth day they received 50 mg/kg morphine. Injection of naloxone (5 mg/kg) induced withdrawal signs such as jumping. The experimental groups received different doses of CCK-8 (0.1, 0.3 and 0.6 mg/kg) and LY225910 (0.01, 0.5 and 1 mg/kg) with each injection of morphine. Injection of CCK-8 significantly decreased the naloxone-induced jumpings, while LY225910 did not have any significant effects on these jumpings. Based on the results of the present study, activation of CCK1 receptors probably is involved in morphine dependence. The results also confirm that injection of CCK but not CCK2 selective antagonist probably decreases the jumpings of mice following withdrawal syndrome of morphine.

Insulin-like growth factor (IGF-1) is a polypeptide that 90 % of it is secreted by liver. Cirrhosis of liver is a condition accompanied with decreased level of IGF-1, and with progression of the disease the level of IGF-1 may be further decreased. In this study the relation between the degree of IGF-1 and severity of liver disease on the basis of Child- Pugh and Model for end stage liver disease(MELD) score is investigated. In this cross sectional study, 100 cirrhotic patients who were diagnosed on the basis of liver biopsy or clinical criteria, referring to the gastroenterology clinic of Imam Khomeini Hospital in Tehran, Iran during the years 2007-2008 were recruited. Laboratory investigations including IGF-1, CBC, liver Enzymes, Alkaline phosphates, serum Albumin, Creatinine, direct and total Bilirubin were carried out for all the patients. Similarly ultrasound for evaluation of ascites and endoscopy for varices were performed. 100 cirrhotic patients with male to female ratio of 63 to 37 and median age of 44.4±15 years were enrolled in the study. This study showed a mean IGF-1 level (± standard deviation) equal to 91.5 ± 92.5ng/dl. Fourteen patients (14%) had IGF-1 within normal limits while 86 patients (86%) had abnormal IGF-1 level. In all patients the correlation coefficient between IGF-1 and MELD was -0.317 (p=0.001) and correlation coefficient between IGF-1 and Child- Pugh was equal to -0.478 (p<0.001). The findings of this study showed that IGF-1 could be an index of severity of cirrhosis and can be used to determine the severity of the disease in patients, in particular, when liver biopsy is not possible.

Soccer coaching is considered to be one of the riskiest careers in the world. The psychological pressure caused by the nature of this profession causes wear to Soccer coaches. The aim of this research was to investigate the effects of acute competition stress on salivary cortisol and heart rate in professional soccer coaches during 2004-2005 competition season. In this descriptive study, salivary samples were collected from coaches at five times (1 hour before the match, at the beginning of the match, during half time break, at the end of the match and one hour after the match). Sixteen professional soccer coaches with the average of 52.27±9.18 years of age, 11.67±6.01 years of coaching experience in the league and 64.40±5.91 beats per minute (bpm) of rest heart rate were selected as the subjects of study. The coaches were monitored with a team polar device throughout the games, during their competition. Analysis of variance with repeated measurements (ANOVA) was used. The highest level of cortisol was observed during the halftime break. This level was higher for the loser coaches than the winner ones. During the game heart rate differences changes were not significant between the loser and winner coaches. Conclousion: The results indicated a hormonal response to competition, which was specially characterized by an anticipatory rise of cortisol depending on outcomes (goal scoring,……). Consequently, psychological stress of competition could be stressful and deterimental for the professional soccer coaches.

Inguinal hernia s account for 75-85% of abdominal wall hernias. Inguinal hernia s are often classified as direct and indirect. The sac of hernia can include intestines, bladder, colons, ovary and appendices. The torsion of greater omentum with unilateral or bilateral inguinal hernia is a rare condition. In the present study a different rare case of inguinal hernia is reported in a 50-year old man. Case report: An abnormal swelling was seen on the right scrotal sac of a 50-year old man's cadaver in dissection room of Rafsanjan Medical School. Before dissection of cadaver, and with regard to the age of the case, the cause of swelling was diagnosed as direct inguinal hernia. Dissection of cadaver showed that the greater omentum is normal and without torsion, but a part of it was placed on the right inguinal canal. This part of omentum had entered the deep ring first and then had gone into canal and finally reached scrotal sac causing mentioned swelling and atrophy of testis. After the dissection of other body parts, some variations were seen. This type of inguinal hernia formed by greater omentum is a rare variation because firstly the involved testis was atrophied. Secondly; there was no torsion in the greater omentum and lastly, with regard to atrophied testis, the hernia was from the embryonic period and had remained from the vaginal excrement. Diagnosis of this type of hernia is difficult for the surgeons especially when there are no clinical signs and pain involved.